Malaria has posed a serious threat to the lives of individuals residing in both tropical and subtropical areas where the disease is endemic, and the poor access to health services. The mortality rates especially in infants, toddlers, and other vulnerable groups keep accelerating, including the incidence rate as a result of no immunity to malaria.
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WHAT IS MALARIA?
Malaria is a life-threatening disease and one of the contemporary issues of Public health that is spread by the vector (female Anopheles mosquito) to humans. It is not contagious, that is, it does not pass from person to person, hand-shaking, kissing, breastfeeding, or sexual intercourse. It is curable and preventable but if not treated on time causes severe problems that can lead to an early grave. In African countries, South Asia, parts of Central and South America, the Caribbean, Southeast Asia, the Middle East, and Oceania, malaria is predominant and has caused lots of deaths.
MODE OF TRANSMISSION
Malaria is a vector-borne disease that develops when an infected female Anopheles mosquito bites an individual, penetrating the skin and transmitting the pathogen, plasmodium parasites species into the body system. This infection begins to manifest in individuals after the transmission of sporozoites into the bloodstream. The movable sporozoites move to the liver where they live in the liver hepatocytes.
There, the parasites begin to hatch and multiply forming the liver schizonts that finally explode discharging thousands of merozoites that migrate to the bloodstream for 2-16 days after the first infection.
There are five malaria parasites which include: Plasmodium falciparum, P. malariae, P. vivax, P. ovale, and P. knowlesi.
The most harmful and commonly seen in African countries is Plasmodium falciparum. It is a deadly disease and can decrease one’s life span if the patient is not given immediate treatment to stop the disease from spreading inside the body. Almost all the people in Africa have suffered from P. falciparum, and even now, the incidence and prevalence rates keep skyrocketing.
The P. vivax is mostly seen outside of sub-Saharan Africa. However, P. knowlesi happened to be a parasite that rarely occurs in humans.
It can also be obtained through blood transfusion, a situation where an infected person’s blood is not thoroughly scrutinized before being transfused to an individual not infected.
Another way it can be transmitted is by using sharps like contaminated needles and syringes, unsterilized lancets, etc used by infected persons.
WHO IS AT RISK OF MALARIA?
Following the increased rate of malaria, the various groups are susceptible to malaria due to low immunity to this ailment. They are:
Infants and under 5 years children who have not developed a strong innate immunity to malaria.
Pregnant women if not treated on time when they have malaria tend to lead to stillbirths, abortion, and premature death of infants.
People living with HIV/AIDS
People who stay where malaria is not endemic and always travel from country to country without taking chemoprophylaxis are also predisposed to malaria.
SYMPTOMS OF MALARIA
The initial clinical manifestation of malaria starts about 10-15 days after being bitten by an infected female Anopheles mosquito. The symptoms appear mild at first but an individual might not know the cause of the signs being experienced.
Mild symptoms like:
Loss of appetite
Fatigue or tiredness
Vomiting or nausea
Shivering or sweating
When one notices some or all of these symptoms, it is paramount that the person seeks his or her doctor’s attention to confirm the cause of his symptoms either through diagnosis or physical examination by the doctor or any other health provider. Treatment should start immediately to prevent severe symptoms from rising.
Most of the severe symptoms include:
(i) Urine color becomes dark or bloody
(ii) Yellowing of the eyes and skin (jaundice)
(iii) Severe tiredness or fatigue
(iv) High rate of convulsions
(vi) Bleeding abnormally
EPIDEMIOLOGY OF MALARIA
As a result of the increased rate of malaria, it was stated that about 247 million people were infected with malaria in 2021 compared with the 2020 report which enunciated that 245 million cases were diagnosed with malaria, and about 619,000 deaths cases were reported according to the World Malaria Report in 2021. The continent having the highest population of malaria worldwide is Africa, as it was already an endemic disease over there.
In 2021, the Region was home to approximately 95% of malaria cases and 96% of malaria deaths. Children under 5 years were the most susceptible group to malaria, and we’re dying as well.
DISEASE BURDEN OF MALARIA IN AFRICA
Malaria is enormously spread throughout tropical and subtropical regions of the world, and Africa carries an excessively high share of the global malaria burden, including both high morbidity and mortality rates. In 2017, there were an estimated 219 million cases of malaria universally. Most were in the WHO African Region, with approximately 200 million cases, or 92% of multinational cases. In 2017, five countries marked nearly half of all malaria cases globally. Four of these were in Africa: Nigeria (25%), the Democratic Republic of the Congo (11%), Mozambique (5%), and Uganda (4%).
VACCINE FOR MALARIA AS RECOMMENDED BY THE WORLD HEALTH ORGANIZATION
World Malaria Day was held on the 25th of April 2023, on that day, it was announced that almost 1.5 million children had developed malaria because of their high susceptibility to it, and over a million had died of malaria in such countries like; Ghana, Kenya, and Malaysia, and they have received the first dose of a malaria vaccine, RTS, S/ASOI known as “Mosquirix”. Most countries have testified to the effectiveness of this drug but the supply is small compared to the unprecedented demand.
Following the high prevalence rate of malaria, children and vulnerable groups keep dying. WHO has recommended a new vaccine known as “R21/Matrix-MTmfor malaria prevention in updated advice on immunization. This vaccine has been directed to be given to children from 5 months to 3 years. It is an intramuscular vaccine. Injections are given through the deltoid region, over 3 dosing periods. It was developed by the University of Oxford and manufactured and scaled up by the Serum Institute of India (SII). This vaccine targets the plasmodium “sporozoite” which is the first form of the malaria parasite entering the human body.
Studies have shown that this vaccine contains Novavax’s Matrix-M “an adjuvant “that heightens the immune system response making it more potent and long-lasting. It has a high efficacy when given just before the high transmission season. The vaccine contains a low dose but can be produced in large quantities and at moderate cost.
However, it has not been dispensed to all countries because the vaccine is passing through different trials.
University of Oxford researchers and their members last year reported from a Phase IIb trial that a booster dose of R21/Matrix-M at one year following a primary three-dose regime sustained high efficacy against malaria, and continued to meet the World Health Organization Malaria Vaccine Technology Roadmap goal of a vaccine with at least 75% efficacy.
Again, following the 2021 results from the Phase-IIb trial reported that R21/Matrix-M illustrated a high-level efficacy of 77%. Recent data from the large phase III trial also show high levels of efficacy and a reassuring safety profile.
Gavi, the vaccine alliance has approved to provide both technical and financial support to roll out this malaria vaccine to 18 countries
OTHER STRATEGIES TO TACKLE MALARIA
According to the World’s Day Malaria theme, it is “time to deliver zero malaria, invest, innovate, and implement”. This means to achieve the malaria goal by 2030, the following measures should be adopted following the vaccine. They are:
- Use of mosquito nets in our various homes
- Scrutinize blood to check for malaria infection before transfusing to another person.
- Mosquito repellents are also important
- Use coils and vaporizers
- Cover up very well by wearing protective clothing
- Use window screens
The World Health Organization aims to eliminate malaria from Africa by 2030, and they are creating strategic ways to ensure that these plans come to manifestation. The new vaccine has not been distributed to diverse countries because it is undergoing different trials.
National Institute of Health
National Institute of Malaria Research
National Library of Medicine, Nat. Rev.Microbiol Author manuscript available in PMC 2014 Mar.4 published in final edited form as Nat. Rev. Microbial. 2013 Dec.11(12); 849-862
Pubmed published by Odunayo Adebukola Temitope Fatunla et al. J Infect Dev Ctries. 2022.Odunayo Adebukola Temitope Fatunla et al. J Infect Dev Ctries. 2022.
WHO/Regional Office for Africa published on the 2nd of October, 2023